Personal Information

First Name: Middle Initial: Last Name:

Street Address: City: State: Missouri Kansas Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming

Phone: (ex: 816-555-1212)   Birth Date: (ex:10/10/01)   Social Sec. No.

Father's Name:   Mother's Name:   Gender:   Male Female

High School or Junior College currently attending:

ACT Score:   SAT Score:   HS GPA:   JC GPA:

Academic interest: 1) 2)

Advisor or Counselor and School:

Basketball Information

Last school to play basketball for:

Height:   Weight:   Position(s):   PPG:

Rebounds/Game:   Assists:   FG%:    FT%:

Daily workout time: hours          Are films available? Yes No

Should you have any questions, please call 816-759-4154; fax 759-4154; or
email: Marcus.Harvey@mcckc.edu

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